Drugged, Drunk or Dying?: Children in the

Mission Impossible
2014 Substance Abuse
Prevention Conference
Drugged, Drunk or Dying?:
Children in the Emergency
Room
By: Jason Martin, RN CEN NREMT-P
Injury Prevention/Outreach Coordinator
CoxHealth Trauma Center
11/2014
Trauma
Why should I care?
¾ of all deaths
What are we talking about?
Growing up today
Alcohol & Drug Use
College Health & Safety
Dating Abuse
Electronic Violence (Cyber Bullying)
Sexual Risk Behaviors
Bullying
Suicide Prevention
Risky Cell Phone Use
Teen Drivers (Distracted Driving)
Teen Pregnancy
Tobacco Prevention
School Violence/Safety
Obesity
Injuries
Behaviors that contribute to unintentional
injuries and violence
What’s injuring/killing our young people?
Healthy Relationship
Risky Cell Phone Use
Drug & Alcohol
Choking game
Pharm Parties
Safe Riding
Bullying
Sexual Assault Prevention
Distracted Driving
Dating: Risky & Normal Behavior
Morning Glory Seeds
Cinnamon Challenge
Shamboiling
Smash
Energy Drinks/Downer Drinks
Ladybug Attractant
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Synthetic Vicodin
Robo Tripping
Kratom
Lemon Drop
Car Surfing/Hill Topping
Krokodil
Bombing
Hammerslaggen
Eye Balling
Wine Enemas
Gravel
Smiles
N-Bomb
Synthetic Xanax
DMT
What is the problem?
› 1350 EMS called to 16 y/o male
› PD called for EMS
› PD arrived to find PT in the backyard of residence that was not
his, he was tazed 5 times and pepper sprayed multiple times. PD
state he was awake, foaming at mouth and skin hot to touch
› EMS found pt in cuffs, prone
› Pt stated his name was JC
› Asked about pain “no, I am JC”
EMS/ER
› Small Laceration to forearm, bruising to wrist noted from cuffs
› EMS V/S: 158/90 150 22 90% Sugar 244
› Multiple marks noted from baton strikes 25-30 times
› Temp 105.0
› Pronounced 30 minutes after arrival
Autopsy (SLU Toxicology)
› Blood
– MDPV 15 MCG/ML (20-30 x more potent)
– Naphyrone : Negative
– Pyrovalerone: Negative
› Urine
– Same as Blood
The Playground
› 13 y/o boy runs out of woods naked screaming and swinging a
bat
› Police called to the scene, sprayed male with pepper spray
multiple times without effect
› Male was tased 5 times
› He was handcuffed and transported to hospital
– Yelling he wants to eat everyone
– Making animal noises
› Attacked a nurse, was tased 12-15 times additionally at hospital
Toxicology: What’s in our kids???
› Alcohol
› Marijuana
› Pills: Vicodin, Percocet,
Morphine, Xanax, etc.
› Meth, Heroin, Cocaine
› Designer Drugs
› Synthetics & Bath Salts
› Regional
Drugs on the Streets….
Update!
MAKING A
COMEBACK?
Purity
NICU
MethHeroin
Local
Area
Cut
OD
Another drug still around….
› LSD (Lysergic acid diethylamide)
– One of the most powerful mood changing chemicals
– Discovered in 1938, manufactured from lysergic acid = ergot = fungus that
grows on rye and other grains
– Changes perception of reality
– Effects: See images, hear sounds and feel sensations that seem real but
are not
– Is it the LSD of the Woodstock days?
› In category with:
– Peyote: Small spineless cactus containing mescaline.
– Psilocybin: Mushrooms
– PCP: 1950 used in medical facilities as anesthetic
› Where are they getting it?
– “Darknet”: Underground web communication and technology most
commonly used for illegal activity and products
› Computer network with restricted access for peer to peer file sharing
› Not going to show up when “Goggled”
› Links to Silk Road 2.0 as well as other similar marketplaces. Most commonly
illegal traded items appear to be hacked PayPal accounts, drugs, fake
passports, etc
The Most Controversial Drug
MJP Facts
› Perception
› How many states call marijuana a medicine?
› Changes in marijuana over the time
› THC vs. CBD
› Hashish Oils and Extracts
Marij uana Billlboards Near t he Super Bowl
"T he Pot Bowl" "T he Stoner BowP, "Th e Weed Bowl"
What is the perception of MJP?
• Increase in availability of marijuana and other
drugs
• Teens being misguided about marijuana as
being a natural product.
• They are unaware of the mood-altering and
physiological effects.
• Has become some-what accepted by society
through media and radio waves
 “My family uses MJP”
 Compare MJP to all other drugs
 Celebrities and Athletes in Media
 Successful people use MJP
› Obama, Oprah, Clinton, Stephen Colbert, Jay Z, Bill Gates,
Labron James, George Clooney, Lady Gaga, Brad Pitt, Tom
Brokaw, Micheal Phillips, Jennifer Aniston, David Letterman,
Morgan Freeman, Angelina J, Martha Stewart, Matt Damon,
Rihanna,…………..
Marijuana is changing
Is the plant changing?
How many states call marijuana a
medicine?
VT
NH
MA
RI
CT
NJ
DE
DC
Legalize Medical Marijuana
Hash Oil Explosions
A clear, golden brown cannabis derivative also known as
honey oil, shatter, wax and (disgustingly) “earwax,” butane
hash oil (BHO)
27
Products such as edibles and balms made
with concentrates are generally referred to
as i n f u s i o n s
Debate Topics
31
Facts:
Marijuana Use Lowers IQ1
A recent study found that those who used marijuana heavily in their
teens and contiued through adulthood showed a permanent drop in
IQ of 8 points.
A loss of 8 IQ points could drop a person of average intelligence
into the lowest third of the intelligence range.
Unknown
Dose?
So how
many other
medicines
people
take…
Are
Smoked?
No
Medical
Exam
Grown
yourself
Is marijuana
really a
medicine?
Take as often as
the pt. thinks
they need it?
Unmeasured
strength
Prescribed
vs.
Recommended
Voted
on by
Public?
Come in
crude
form?
Contain no
warnings
of harm?
Its all natural…
Comes from the earth…
Mother nature…
• Pt will have recurrent nausea, vomiting and
colicky abdominal pain
• Patients will state the only thing that helps is long
hot showers or hot bath
• Resolution for symptoms after stopping cannabis
use
• Most patients will state they are unable to stop
smoking marijuana even after they recognize
the association between their symptoms and
marijuana consumption
Reactions resembles a heart attack, stroke or anxiety attack
Eating 100mg edible would be like smoking 20 hits of marijuana
Luring to children because of packaging
Domestic violence, assaults and “other trauma”
No longer a “bean bag” activity
MVC, MCC, ATV, Bicycle, hunting……………
Marijuana: My Point
› Don’t drive
– “Even small amounts of marijuana can double the chances of a driver
crashes with larger doses tripling the chances.”
(British Medical Journal, 2005)
– “Risk of automobile crash is 2.7 times higher amoung mariuana users
that non” (Columbia University School of Public Health)
– ½ of drug related crashes are from marijuana in Colorado (Highway Safety
Manager CO DOT)
– 75% of teens do not believes smoking marijuana adversely affects their
driving
› Know your laws in your state
Synthetic MJP/Bath Salt update
So how is it made?
Flavor Added to Spice
› Cotton Candy
› Bubble Gum
› Juicy Fruit
› Strawberry
› Fruit Punch
› And more
Spice Effects on Mind & Body
› Agitation
› Increased blood pressure
› Anxiety including extreme
panic attacks
› Increased heart rate
› Depression
› Cardiac arrest
› Paranoia
› Blood shot eyes
› Psychosis
› Insomnia
› Hallucinations
– Visual
– Auditory
› Tingling, numbness
› Flashbacks
› Vomiting
› Brain Seizures
› Tremors
› Suicidal Thoughts?
Bath Salts – Synthetic Stimulants and others -What
are They?
› A very dangerous
synthetic drug
› Are NOT used for
Baths!
› Deliberately
Mislabeled
› “Not For Human
Consumption”
Where is it being sold and how is displayed?
Sold mostly in independent mom and pop type
stores, convenience stores, gas stations or on the
internet.
How you take them?
› Inhalation
› Keying
› Parachuting/Bombing
› IV
› Bootie Bumping/Keistering
Cost:
$20-$50 per
package
Addictive/Abusive Properties of “Bath Salts”
● extreme/highly addictive property
● intense craving
● binging
Ingredients
› Codeine
› Paint Thinner
› Gasoline
› Hydrochloric Acid
› Iodine
› Red Phosphorus
– 30 minutes to make
– High for 90-120 minutes
– ½ cost of heroin
We have enough to worry about….. (DIY drugs)
• Paco (Argentina)
– Cocaine leaf paste, crushed glass, rat poison and Kerosene
• SISA (Greece)
– Battery acid, shampoo, salt and unknown meth product
• Wungu (South Africa)
– Rate poison, marijuana and antiretroviral (HIV) drug
Toad Licking
› Bufotenine (5-hydroxy-N-Ndimethyltryptamine) is a Schedule I
substance found in certain
mushrooms, seeds, and skin glands of
Bufo toads. In general, most
bufotenine preparations from natural
sources are extremely toxic.
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Ketamine
Xylazine (Anesthesia)
› Dental Work and Castration
› Causes users to fall in/out of consciousness
› Often stoops when walks
› High can last up to 6 hours
› IV Preferred route
Synthetic Xanax
Phenazepam
Developed in 1978 in Soviet Union
› Used in Russia for TX of neurological disorders such as
epilepsy, ETOH withdrawal and insomnia
› 1mg is equivalent to 10mg Diazepam
› Dose is 0.5mg-2mg (erowid)
› Pharmaceutical ½ life of 60 hours
› S/E: Hiccups, dizziness, loss of coordination and other
benzo side effects
Relax Max Bars
AKA: “Zannie” Air Freshener
Mr. Smiley Products
› Under U.S. Law phenazepam is not currently classified as a
controlled substance. The Federal Analog act only provides for
auto assumed classification of chemicals “substantially similar”
to Schedule 1 or 2 drugs.
› Benzodiazepines are schedule IV
› Not controlled but still sale for human use remains illegal in the
U.S.
› Circumvent this regulation by
“NOT FOR HUMAN CONSUMPTION”
LOUISIANA/ARKANSAS
Molly: MDMA
Pure Form of Ecstasy
› Methylene DioxyMethAmphetamine
› Miami/NY Molly: Mix of bath Salts, Meth, and
MDMA mixture.
›One capsule had: Cocaine, Meth, Unk Opiate
›Death in NY: Toxicology reveled MDMA &
Methylone
Arylcylohexamines:
Methylhexanamine
(DMAA)
KC Synthetic
Drug
Marked as “enhanced plant vitamin – not for human consumption.”
Characteristics include:
 Quickly addictive
 Stimulates the central nervous system (like meth).
 Can lead to severe psychosis (and suicide)
 Encountered on designer drug market as a cathinone replacement. Also found on
the dietary supplement market
Gravel
Kratom
Suboxone (Buprenorphine)
INHALENTS
ENERGY DRINKS
Lanna Hammann
6/17/2014
11
Monster
drinks
34 Deaths from
energy drinks
(2004)
1
Rockstar
22
5 Hour
Energy
Downer Drinks
Lazy Cakes / Dietary Supplement
aka.
The Relaxation Brownie
Dextromethorphan (DXM)
› Other names:
–DXM, Dex, Dexing, Orange Crush, Poor mans PCP, Red
Devils, Robo, Robo-tripping, Skittling, Triple C’s, Vit-D
› Abused for the past 30 years
› Chemically R/T opiates
› Compared to Ketamine or PCP
› Blocks the Dopamine reuptake site, activates the sigma receptor
What do they take?
› Products that contain the cough suppressant Dextromehtorphan
› Active ingredient “Dextromethorphan hydrobromide”
–Tussidex, Triaminic, Vicks 44 Cough, Zicam, PediaCare
Childrens Long Acting Cough, Delsym
› What else is in the product?
–Benadryl, Tylenol, etc.
› Is the child taking any meds that would interact?
– MAOI’s (Can lead to serotonin syndrome)
– Diet Drugs
Why they take it
› 4 Different levels or plateaus: (Levels very)
– First: 100mg-250mg: Very empathetic, robo walking followed by drippy
feeling. Party dose
– Second: 250mg-450mg: More euphoria, decreased sense of surrounding
– Third: 450mg-800mg: Hallucinations are present, mostly in spirals or
visions of fluid
– Fourth: 800mg-1800: Out of body experience
– Fifth: >1800: Overdose
(Robotussin Max Strength 354MG)
“Anything above 1200mg you should be close to hospital”
› S/S will depend on the does and other drugs in the system:
– Profuse sweating
– Extreme Nausea
– Blackouts
– Respiratory depression
– Vision
– Tachy
– Spasm of the abd and intestines
– Can last up to 48 hours
› Treatment is supportive
› Is there any reversal agents for DXM?
Who am I??
› I am a powerful stimulant
› I come in many forms
› You can buy me by the gallon or even barrel
› I am legal in your state
› I come in flavors like bubble gum, cherry and chocolate
› You can drink me or rub me into your skin to get high
› But be careful because a teaspoon full of me can kill a child
› In 2013 we had a 300% increase in number of people
poisoned from me
NICOTINE
› E-Juice or Rock Juice
› No FDA
› No tamper proof lids
› Middle School
–Online
WHAT DOES ALL THIS MEAN??
Choice 1
More often than you think!!!
HILLTOPPING??
By: Jason Martin, RN CEN NREMT-P
[email protected]
417-269-0920
417-893-1990

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